‘Silver Surge’: Who Will Take Care of Aging Boomers?

It’s often called the “silver tsunami”—a tidal wave of 78 million boomers who begin turning 65 less than three years from now and, according to recent reports, threaten to overwhelm a health and caregiving system ill prepared to cope with them. 

The phrase is catchy but overly pessimistic, experts say. “A tsunami is an unexpectedly large wave that occurs suddenly,” says Richard Suzman, director of behavioral and social research at the National Institute on Aging. The boomer generation “is also a huge wave, but it builds slowly, allowing for decades of adjustment, rather than minutes.” Nonetheless, he adds: “This is a huge demographic, economic and social shift. The world has never seen anything like it.”

The boomers—defined as Americans born between 1946 and 1964—will join the ranks of Medicare beneficiaries slowly but with gathering momentum. Their coming of age is more like a silver surge than a tsunami. In 2011, the first wave of 2.7 million will turn 65, and each succeeding year the swell gets higher until it peaks in 2025 with 4.2 million new 65-year-olds, according to U.S. Census projections.

It’s the cumulative effect of that surge—plus the fact that people are living far longer then ever before—that poses a looming crisis for the health care system. By 2030, when the youngest boomers have become seniors, the number of Americans 65 and older is expected to be more than 70 million, nearly twice as many as in 2005 and a jump from 12 to 20 percent of the whole population, according to a new report from the National Academies Institute of Medicine (IOM).

“They will face a health care workforce that is too small and woefully unprepared to meet their specific health needs,” the IOM said. “If our aging family members and friends are to live as robustly as they can and in the best health possible, we must have a workforce of adequate size and competency to take care of them.”

The IOM report, Retooling for an Aging America: Building the Health Care Workforce, calls for “bold initiatives” to start training health care providers and family caregivers immediately for the coming demand. Some highlights:

• A serious shortage of doctors, nurses and other health professionals. By 2030, at least 3.5 million more will be needed, a 35 percent jump from current levels. Providers themselves are aging. By January 2007 nearly one-fourth of active physicians were already 60 or older. By 2020, half of registered nurses will be 50-plus.

• An acute shortage of geriatricians: Only 7,100 doctors are now certified in geriatrics (all-round care for older patients), one for every 2,500 Americans over 65. By 2030 the likely number will fall far short of the 36,000 specialists needed.

• Geriatric training for all health professionals: Many doctors who treat large numbers of older patients are not required to have any training in geriatric care. Direct-care workers, such as aides in nursing homes, often receive fewer hours of training than dog groomers, manicurists and crossing guards.

• Higher salaries for specialists in geriatric care: Geriatricians earn less than other specialists, despite longer training and more challenging work—around $163,000 on average compared with $175,000 for general internists and $300,000 for dermatologists. Many direct-care workers earn wages below the poverty level, causing high turnover in their jobs.

• Training family members and other voluntary caregivers: More than 90 percent of older Americans who receive care at home rely on family, friends or other unpaid volunteers. Training programs—perhaps by nonprofit hospitals as a way of earning their tax-free status—could help caregivers provide proper assistance and alleviate their stress.

• Changing Medicare’s approach: Medicare “hinders the provision of quality care” by paying providers too little, focusing on treating acute health problems instead of chronic conditions and failing to cover enough preventive services. The agency should adopt new models of care delivery—such as interdisciplinary teams of providers—to improve patients’ health and lower costs, the report said.